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Lookup NU author(s): Steven White
This work is licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0).
© 2023, The Author(s).Background: Although robotic distal pancreatectomy (RDP) has a lower conversion rate to open surgery and causes less blood loss than laparoscopic distal pancreatectomy (LDP), clear evidence on the impact of the surgical approach on morbidity is lacking. Prior studies have shown a higher rate of complications among obese patients undergoing pancreatectomy. The primary aim of this study is to compare short-term outcomes of RDP vs. LDP in patients with a BMI ≥ 30. Methods: In this multicenter study, all obese patients who underwent RDP or LDP for any indication between 2012 and 2022 at 18 international expert centers were included. The baseline characteristics underwent inverse probability treatment weighting to minimize allocation bias. Results: Of 446 patients, 219 (50.2%) patients underwent RDP. The median age was 60 years, the median BMI was 33 (31–36), and the preoperative diagnosis was ductal adenocarcinoma in 21% of cases. The conversion rate was 19.9%, the overall complication rate was 57.8%, and the 90-day mortality rate was 0.7% (3 patients). RDP was associated with a lower complication rate (OR 0.68, 95% CI 0.52–0.89; p = 0.005), less blood loss (150 vs. 200 ml; p < 0.001), fewer blood transfusion requirements (OR 0.28, 95% CI 0.15–0.50; p < 0.001) and a lower Comprehensive Complications Index (8.7 vs. 8.9, p < 0.001) than LPD. RPD had a lower conversion rate (OR 0.27, 95% CI 0.19–0.39; p < 0.001) and achieved better spleen preservation rate (OR 1.96, 95% CI 1.13–3.39; p = 0.016) than LPD. Conclusions: In obese patients, RDP is associated with a lower conversion rate, fewer complications and better short-term outcomes than LPD.
Author(s): Ausania F, Landi F, Martinie JB, Vrochides D, Walsh M, Hossain SM, White S, Prabakaran V, Melstrom LG, Fong Y, Butturini G, Bignotto L, Valle V, Bing Y, Xiu D, Di Franco G, Sanchez-Bueno F, de'Angelis N, Laurent A, Giuliani G, Pernazza G, Esposito A, Salvia R, Bazzocchi F, Esposito L, Pietrabissa A, Pugliese L, Memeo R, Uyama I, Uchida Y, Rios J, Coratti A, Morelli L, Giulianotti PC
Publication type: Article
Publication status: Published
Journal: Surgical Endoscopy
Year: 2023
Volume: 37
Pages: 8384–8393
Print publication date: 01/11/2023
Online publication date: 15/09/2023
Acceptance date: 30/07/2023
Date deposited: 05/10/2023
ISSN (print): 0930-2794
ISSN (electronic): 1432-2218
Publisher: Springer
URL: https://doi.org/10.1007/s00464-023-10361-x
DOI: 10.1007/s00464-023-10361-x
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